Provider Demographics
NPI:1790853216
Name:DEMETER, STEPHEN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LOUIS
Last Name:DEMETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 JOSEPHINE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0374
Mailing Address - Country:US
Mailing Address - Phone:808-381-3478
Mailing Address - Fax:702-912-0342
Practice Address - Street 1:2925 JOSEPHINE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0374
Practice Address - Country:US
Practice Address - Phone:808-381-3478
Practice Address - Fax:702-912-0342
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38039207R00000X, 2083X0100X
NV16722207RP1001X
HIMD125562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79182Medicare UPIN
OHDE0471862Medicare ID - Type Unspecified